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In the wake of the Millennium Development Goals, the focus on vulnerability and access to care has increasingly gained ground in the malaria social science literature. However, little emphasis has been given to the cumulative processes of vulnerability. In this article, we draw on ethnographic data, in particular on case studies, gathered in southeastern Tanzania in the 1990s and reexamine them in the context of vulnerability. We analyze the underpinnings of the cumulative dimension of vulnerability at three levels: (1) structural, that is, elements that determine access to material and social resources; (2) agent driven, that is, the consequences of coping strategies that enhance vulnerability; and (3) conjunctural, that is, periods characterized by the confluence of adverse circumstances. We argue that the analysis of cumulative processes of vulnerability paints a more comprehensive picture of people's struggle for health. This opens up a more systemic and dynamic perspective on access to care for disadvantaged populations. [ABSTRACT FROM AUTHOR]

What kind of knowledge about illness determines treatment action? The authors explore this question after encountering a paradox in the course of an ethnographic study on Malaria in Tanzania. Why did Tanzanian mothers who knew about the link between degedege -- a local term to describe convulsions in children -- and malaria still use traditional practices for degedege, even though they would never use these for malaria? Through questionnaires, in -- depth interviews, and ethnographic fieldwork, the authors repeatedly elicited and observed seemingly irrational behaviour (for example, urinating over a child, rubbing the child's body with elephant dung, etc.), which their informants could not explain. Informants routinely commented that "this is what we have always done" or "this is what everybody does". In this paper, the authors suggest that SchÜtz's (1964) idea of "recipe knowledge" -- culturally learned formulas that are automatically activated and remain unquestioned as long as nothing unforeseen happens -- offers an explanation for such observed behaviour. In the case of degedege, the "recipes" are embedded in a wider schema for action that combines traditional and biomedical practices, and thereby integrate social values of "tradition" and "modernity". These findings reflect on the limitation of classical knowledge transmitted through health messages for behaviour change, and shed light on the role of historical and social context in knowledge construction and therapeutic action. [ABSTRACT FROM AUTHOR]

Examines the influence of medical syncretism on the treatment of malaria in Tanzania. Manifestations of the disease; Process of medical syncretism; Importance of health education programs in improving the knowledge about the disease.

Lay perspectives and health-seeking behaviour for malaria were investigated in an ethnographic study carried out in a village in south-eastern Tanzania. The inhabitants have easy access to hospital services and education programmes, and as a result, biomedical knowledge on malaria is comparatively high. However, the cultural model of malaria does not always explain all the events that occur during an actual illness episode, e.g. when the disease cannot be detected at the hospital or the symptoms persist despite antimalarial treatment. Under these circumstances, the model of malaria may be complemented with the logic of witchcraft. This can lead people to consult sequentially both biomedical and traditional health services for the same illness episode. The consequences can include non-compliance with treatment or delay in seeking diagnosis or treatment. Our analysis offers elements for the understanding of aspects of the dynamics of reinterpretation and health-seeking behaviour for malaria, particularly in the phase after diagnosis and treatment at a biomedical health facility. The research is presented with an applied perspective. We propose specific recommendations that could be discussed with health promoters. [ABSTRACT FROM AUTHOR]